What not to eat with coeliac disease and why early diagnosis matters

Many adults live with coeliac disease for years without knowing it. Understanding unsafe foods, hidden gluten and early testing can protect long-term health

For many people, avoiding gluten sounds like a lifestyle choice. For those living with coeliac disease, it is a medical necessity. Contrary to popular belief, coeliac disease is not a food intolerance or dietary preference. It is a lifelong autoimmune disorder in which ingestion of gluten triggers immune-mediated damage to the small intestine, leading to inflammation, malabsorption and a wide range of health complications.

 

“Despite increasing awareness, delayed diagnosis and accidental gluten exposure remain common, particularly in adults,” says Dr Sanjay Kumar, Senior Director, Institute of Digestive and Liver Disease, Max Super Speciality Hospital, Noida. Understanding what foods to avoid, who is at risk, and why symptoms vary so dramatically is central to effective disease control.

 

 

Who is more vulnerable to coeliac disease?

 

Coeliac disease occurs in genetically susceptible individuals, especially those carrying HLA-DQ2 or HLA-DQ8 genes. However, genetics alone does not determine who will develop the condition.

 

Risk is significantly higher among

• First-degree relatives of affected individuals
• People with type 1 diabetes
• Those with autoimmune thyroid disease
• People with Addison’s disease or autoimmune hepatitis
• Those with Down syndrome or Turner syndrome

 

Women are diagnosed more frequently than men, informs Dr Kumar. While often associated with childhood, coeliac disease can develop at any age, including late adulthood.  ALSO READ | Gluten-free diet explained: Who needs it, medical tests and safe swaps 

Why symptoms vary so widely

 

The clinical presentation of coeliac disease is remarkably diverse. This variation depends on the extent and location of intestinal damage, differences in immune response, gut microbiota, and how long the disease has remained untreated.

 

• Some individuals experience classic digestive symptoms such as diarrhoea, bloating and weight loss.
• Others present with iron-deficiency anaemia, osteoporosis, infertility, migraine, depression, neuropathy or chronic fatigue.

 

Many adults have what is known as  silent or atypical coeliac disease, where gastrointestinal symptoms are absent. Instead, patients may report persistent tiredness, hair loss, nutritional deficiencies, menstrual irregularities or recurrent miscarriages.

 

“The intestine may be severely affected even when gastrointestinal symptoms are minimal or absent,” says Dr Kumar.

 

As these symptoms are non-specific, diagnosis is often delayed for years, allowing progressive intestinal and systemic damage.

 

How coeliac disease is tested and what it costs

 

Testing for coeliac disease must be done before starting a gluten-free diet, as removing gluten can cause test results to normalise.

 

Doctors usually begin with blood tests that detect antibodies linked to gluten-induced intestinal damage, most commonly the tTG-IgA test, along with total IgA levels.

Approximate cost: ₹400–₹1,800

 

If blood tests are positive, diagnosis is confirmed through an upper gastrointestinal endoscopy with a small intestinal biopsy.

Approximate cost: ₹2000–₹10,000

 

In selected cases, genetic testing for HLA-DQ2 or HLA-DQ8 may be used to rule out the disease.

Approximate cost: ₹4,500–₹7,500

 

Unsafe foods for people with coeliac disease

 

Grains and flours

• Wheat (atta, maida, sooji/semolina, durum, spelt)
• Barley
• Rye
• Bran, wheat germ

 

Bakery and processed foods

• Bread, buns, pizza bases
• Cakes, biscuits, cookies, pastries
• Pasta, noodles, vermicelli
• Rusks, crackers, breadcrumbs

 

Packaged and ready-to-eat foods

• Breakfast cereals (unless labelled gluten-free)
• Instant soups and noodles
• Sauces and gravies thickened with wheat flour
• Regular soy sauce, malt vinegar
• Salad dressings and marinades
• Spice mixes with added flour

 

Processed proteins

• Sausages, nuggets, patties
• Imitation or vegetarian meat substitutes
• Breaded or battered foods

 

Beverages and additives

• Malted drinks
• Beer and barley-based alcohol

 

Hidden and overlooked sources

• Oats not certified gluten-free
• Medications, supplements or cosmetics containing wheat derivatives
• Foods labelled “multigrain” or “brown” (often contain wheat)

 

“Even trace amounts of gluten is sufficient to trigger intestinal injury,” Dr Kumar explains.

 

Safe foods for people with coeliac disease

 

Grains and cereals

• Rice
• Jowar (sorghum)
• Bajra (pearl millet)
• Ragi (finger millet)
• Maize (corn)
• Buckwheat (kuttu)
• Amaranth (rajgira)
• Quinoa

 

Pulses and legumes

• All dals and lentils
• Chickpeas, rajma, chole
• Beans and peas (unprocessed)

 

Fresh produce

• All fresh fruits
• All fresh vegetables

 

Dairy and protein

• Milk, curd, paneer
• Eggs
• Fresh, unprocessed meat, poultry and fish

 

Nuts, seeds and fats

• Peanuts, almonds, cashews, walnuts
• Seeds (chia, flax, sunflower, pumpkin)
• Ghee, butter, cooking oils

 

Packaged foods

• Certified products clearly labelled “gluten-free”

 

Accidental gluten exposure: A hidden challenge in India

 

Despite best intentions, accidental gluten ingestion is common in Indian households. Shared cooking surfaces, rolling boards and fryers, mixing of wheat flour with rice or lentils during storage, restaurant gravies and spice mixes, unclear labelling, and festive foods all increase risk.

“Gluten-free in practice does not always mean medically safe unless cross-contamination is meticulously avoided,” Dr Kumar cautions. Separate utensils, cooking surfaces and storage are essential for medical safety.

 

Why early diagnosis changes outcomes

 

Untreated coeliac disease increases the risk of

• Malnutrition
• Weak bones
• Infertility
• Neurological complications 
• Intestinal cancers

Early diagnosis followed by a lifelong, strictly gluten-free diet allows intestinal healing, symptom resolution and long-term health preservation. With proper dietary counselling and follow-up, most patients can lead full, active lives.

 

Key precautions for living safely with coeliac disease

 

Read labels carefully: Gluten or gluten-derived ingredients can hide in packaged foods, supplements and even non-food products like toothpaste, lipstick, lip balm.

Monitor children’s growth: Regularly tracking height and weight in children with coeliac disease is essential to ensure timely detection of deficiencies.

Do not self-prescribe a gluten-free diet: Always consult a doctor before eliminating gluten. Starting a gluten-free diet before testing can delay or obscure an accurate diagnosis.

Get screened if coeliac disease runs in the family: First-degree relatives of people with coeliac disease have a higher risk and should seek medical advice and testing, even if symptoms are mild or absent.

   

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This report is for informational purposes only and is not a substitute for professional medical advice.